Drilldown: Medicines

None · Codeine · 1,4-Butanediol · 1B-LSD · 1cP-LSD · 1P-LSD · 1V-LSD · 2-AI · 2-FA · 2-FDCK · 2-FMA · 25B-NBOH · 25B-NBOMe · 25C-NBOH · 25C-NBOMe · 25I-NBOH · 25I-NBOMe · 25N-NBOMe · 2C-B · 2C-B-FLY

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Auvelity (dextromethorphan/bupropion ER) (1) · Caplyta (1) · Kisunla (1) · Leqembi (1) · Quviviq (1) · REL-1017 / esmethadone (investigational; not yet FDA-approved as of mid-2024) (1) · Spravato (1) · Trintellix (US), Brintellix (formerly) (1) · Viibryd (1) · Vraylar (1) · Wakix (1) · Zithromax, Z-Pak, Zmax (1) · Zulresso (1)

5HT2A/D2 antagonist with proposed differential pre/post-synaptic D2 activity (1) · Anti-amyloid beta (Aβ) monoclonal antibody (2) · Atypical antipsychotic (2) · D2/D3/5HT1A partial agonist (1) · dissociative (1) · Dual orexin receptor antagonist (DORA) (1) · GABA-A positive allosteric modulator (1) · Histamine H3 receptor inverse agonist / antagonist (1) · low-trapping) (1) · Multimodal antidepressant: SERT inhibitor + 5HT1A agonist + 5HT1B partial agonist + 5HT3/5HT7 antagonist (1) · Neuroactive steroid (1) · NMDA receptor antagonist (uncompetitive (1) · NMDA receptor antagonist (uncompetitive) (1) · NMDA receptor antagonist + sigma-1 agonist + NDRI (combination) (1) · Serotonin partial agonist reuptake inhibitor (SPARI) (1) · targets protofibrils (1) · targets pyroglutamated Aβ in plaques (1) · wake-promoting agent (1) · [[:Category:Azalides|Azalide]] (1) · [[:Category:Macrolide_antibiotics|Macrolide antibiotic]] (1)

None · 5-HT2A agonist · GABAA positive allosteric modulator · Monoamine releasing agent · CB1/CB2 agonist · Potent mu-opioid receptor agonist · Sodium channel blocker · Dopamine/norepinephrine reuptake inhibitor · GABAA potentiator; NMDA antagonist · Phenothiazine D2 antagonist · Potent 5-HT2A agonist · 5-HT1B/1D agonist · LSD analogue; 5-HT2A agonist · Mu-opioid receptor agonist · Muscarinic receptor antagonist · Prodrug of LSD; 5-HT2A agonist · Selective norepinephrine reuptake inhibitor · GABAA positive allosteric modulator (non-benzodiazepine) · GABAA potentiator and direct activator · Irreversible non-selective MAO inhibitor

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Alzheimer disease (MCI or mild dementia stage), FDA-approved July 2024 (1) · Alzheimer disease (MCI or mild dementia stage); FDA accelerated approval Jan 2023 → traditional approval July 2023 (1) · Excessive daytime sleepiness or cataplexy in adults with narcolepsy (FDA-approved August 2019) (1) · Insomnia (sleep onset and/or sleep maintenance) in adults (FDA-approved Jan 2022) (1) · Investigational for major depressive disorder; trials underway (phase 3 mixed results) (1) · Major depressive disorder in adults (FDA-approved 2011) (1) · Major depressive disorder in adults (FDA-approved 2013). Notable for evidence of cognitive benefit (processing speed) that distinguishes it from other antidepressants. (1) · Major depressive disorder in adults (FDA-approved August 2022) (1) · Postpartum depression (PPD) in adults (1) · Schizophrenia (FDA-approved 2015). Acute manic or mixed episodes of bipolar I disorder. Bipolar I depression (FDA-approved 2019). Adjunctive treatment of major depressive disorder (FDA-approved Dec 2022). (1) · Schizophrenia (FDA-approved Dec 2019). Bipolar depression as monotherapy or adjunct to lithium/valproate (FDA-approved Dec 2021). (1) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-000003F6-QINU`"', '"`UNIQ--vote-000003F7-QINU`"', '"`UNIQ--vote-000003F8-QINU`"', '"`UNIQ--vote-000003F9-QINU`"', '"`UNIQ--vote-000003FA-QINU`"', '"`UNIQ--vote-000003FB-QINU`"' (1)

1 tablet (dextromethorphan 45 mg / bupropion 105 mg) PO daily × 3 days, then increase to 1 tablet BID (1) · 10 mg PO once daily × 7 days, then 20 mg × 7 days, then 40 mg as target dose (take with food) (1) · 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed (1) · 10 mg/kg IV every 2 weeks (1) · 25 mg PO at bedtime (no titration); may increase to 50 mg if 25 mg inadequate (1) · 42 mg PO once daily with food (no titration) (1) · 500 mg PO day 1, then 250 mg PO daily days 2-5 (Z-Pak); 1 g PO single dose for chlamydia; pediatric dosing 10 mg/kg day 1, 5 mg/kg days 2-5 (1) · 700 mg IV q4w × 3 doses, then 1400 mg IV q4w; may discontinue when amyloid PET shows clearance (1) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1) · Schizophrenia: 1.5 mg PO daily, increase to 1.5-6 mg as tolerated. Bipolar mania: 1.5 mg, may increase to 3-6 mg. Bipolar depression: 1.5 mg daily for 14 days, then 3 mg. MDD adjunct: 1.5 mg, may increase to 3 mg. (1) · Single 60-hour continuous IV infusion: 30 mcg/kg/h × 4h → 60 mcg/kg/h × 20h → 90 mcg/kg/h × 28h → 60 mcg/kg/h × 4h → 30 mcg/kg/h × 4h (1) · Trials use 25 mg or 50 mg PO daily (1) · Week 1: 8.9 mg PO once daily in the morning. Week 2: 17.8 mg. Week 3+: 35.6 mg (max). Titrate as needed. (1)

1.5 mg, 3 mg, 4.5 mg, 6 mg capsules (1) · 10 mg, 20 mg, 40 mg tablets (1) · 100 mg/20 mL vial, single-use (1) · 200 mg/2 mL, 500 mg/5 mL vials for IV infusion (1) · 25 mg, 50 mg tablets (1) · 250 mg, 500 mg, 600 mg tablets; 100, 200 mg/5 mL suspension; 2 g ER suspension (Zmax); 500 mg IV (1) · 28 mg/device (each dose uses 2 devices) (1) · 350 mg/20 mL vial for IV infusion (1) · 4.45 mg, 17.8 mg tablets (1) · 42 mg capsules (1) · 5 mg, 10 mg, 20 mg tablets (1) · Dextromethorphan 45 mg + bupropion 105 mg ER tablets (1) · Investigational oral capsule (1)

10 mg/kg q2w (1) · 1400 mg q4w (1) · 2 tablets/day (dextromethorphan 90 mg / bupropion 210 mg) (1) · 20 mg/d (1) · 35.6 mg/d (1) · 40 mg/d (1) · 42 mg/d (1) · 50 mg/d (1) · 500 mg/d (typical regimen); single 2 g for Zmax; 2 g for select STIs (1) · 6 mg/d (psychosis/mania); 3 mg/d (depression adjunct) (1) · 84 mg per session (1) · Not yet approved (1) · Single 60-hour course (1)

Intranasal (under direct medical supervision) (1) · Intravenous (continuous infusion in a REMS-certified facility) (1) · IV (1) · IV infusion (60 min) every 2 weeks; outpatient or infusion-center setting (1) · IV infusion every 4 weeks (1) · Oral (9)

4-6 weeks for full antidepressant effect (claimed earlier onset for some patients due to 5HT1A partial agonism) (1) · Amyloid PET clearance within months; cognitive benefit over 18 months (1) · Antidepressant effect within hours of infusion start; sustained at 30 days (1) · Antipsychotic effect over weeks (1) · Clinical improvement within 24-72 hours (1) · Rapid (within 1 week in trials) (1) · Significant antidepressant response by week 1 in trials (faster than monoaminergic antidepressants which take 4-6 weeks) (1) · Slowing of cognitive decline over 18 months (modest effect, ~27% relative slowing) (1) · Typical antidepressant 4-6 week onset (1) · Wake-promoting effect over weeks of titration (1) · Weeks for psychosis/mood efficacy (1) · Within hours of first administration (1) · ~30 min (1)

Acute effect ~24 hours; cumulative effect builds with repeated dosing (1) · Daily dosing (4) · Daily dosing; active metabolites with very long half-lives (up to 1-3 weeks) (1) · Daily morning dosing (1) · Ongoing dosing (1) · Single infusion course (1) · Sustained with twice-daily dosing (1) · Tissue half-life supports once-daily and post-treatment effect (1) · Treatment can be discontinued upon achieving amyloid clearance (1) · ~7-8 hours (1)

Cariprazine ~2-4 d; major active metabolites desmethyl-cariprazine (DCAR) ~1-3 weeks → 'oral depot' effect with delayed steady-state and reduced effect of missed doses (1) · Dextromethorphan ~22 h (when CYP2D6 inhibited); bupropion ~21 h (1) · Not formally established (1) · ~12.1 days (1) · ~18 hours (terminal) (1) · ~20 hours (1) · ~25 hours (1) · ~5-7 days (1) · ~66 hours (1) · ~68 hours (terminal; reflects deep tissue accumulation, much longer than plasma)'"`UNIQ--ref-000003FC-QINU`"' (1) · ~7-12 hours (1) · ~8 hours (shorter than suvorexant and lemborexant) (1) · ~9 hours (terminal) (1)

100% (IV) (3) · Adequate oral bioavailability (1) · Limited but adequate; take with food (1) · Not formally characterized for the combination (1) · Not formally established; oral once-daily adequate (1) · Oral bioavailability suitable for daily dosing (1) · ~37% (oral; food reduces absorption modestly)'"`UNIQ--ref-000003FD-QINU`"' (1) · ~48% intranasal (1) · ~62% (1) · ~72% (with food); much lower fasting (~36%) (1) · ~75% (1)

Avoid; may cause fetal harm (1) · Generally considered safe; commonly used in pregnancy when macrolide indicated.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Investigational (1) · Limited data (3) · Limited data; avoid (2) · Limited data; National Pregnancy Registry for Atypical Antipsychotics (1) · Limited data; pitolisant may reduce hormonal contraceptive efficacy (1) · Limited data; weigh benefits/risks (2) · Medicine is structurally identical to endogenous allopregnanolone; pregnancy considerations relate to breastfeeding during/after infusion. Limited data; brief interruption of breastfeeding considered (1)

Investigational (1) · Rx (5) · Rx, '''not a controlled substance''' (unique among wake-promoting agents) (1) · Rx, Schedule III (US). REMS program required. (1) · Rx, Schedule IV (US) (1) · Rx; ARIA monitoring required (1) · Rx; REMS program required (excessive sedation/loss of consciousness during infusion) (1) · Rx; REMS-like program for ARIA monitoring (1) · [[USLegal:Prescription only|Rx-only]] in US (1)